what HSA's really do is separate the young from the old, the well from the sick. Currently, insurance operates off of the concept of risk pooling. Since health costs tend to be unpredictable and illness isn't thought a moral failing, we all pay a bit more than we expect to use in order to subsidize those who end up needing much more than they ever thought possible. The well subsidize the sick, the young subsidize the old, and we all accept the arrangement because one day we will be old, and one day we will be sick, and no one wants to shoulder that alone.

But HSA's slice right through this intergenerational, redistributionist arrangement: they're a great deal for young, healthy folks because they don't force subsidization. Just don't get sick...

I am really, really, really disgusted. This is totally immoral, and one of the worst examples of "the market takes care of everything" attitude. The market is not going to save your life if you are too afraid to go to the emergency room because you have no REAL health insurance and you have to pay all your medical costs out of a savings account you can't really afford to pay into. The market is not going to magically let you know whether that lump is a cyst or a tumor or just an ingrown hair. The market is not going to treat your diabetes or chronic back problems at a price you can actually afford. The loving invisible hands of the market won't magically reach out and stop you from falling down the stairs and breaking your goddamn leg.

The market doesn't care if you live or die, and neither does Bush. Where did he get the idea that the problem with healthcare in this country is that too many people are going to the doctor for no reason just because they can? Does he really think people sit around drunk and bored and then say to their buddies "Dude, let's go to the doctor and run up health costs by getting colonoscopies and X-rays!" Yes, sitting in a crowded waiting room for hours surrounded by coughing people and being poked and prodded and having cameras stuck in your private bits while wearing weird ill-fitting cotton things that don't cover your ass is the new selfish hedonistic pursuit of choice.
I feel a cartoon coming on. Oh, and if you have access to the Wall Street Journal, a very succinct and clear analysis here.

Update: Guess who LOVES the idea of HSA's, just like they loved the idea of Social Security Privatization? Wall Street, that's who. The lobbying is already in full swing.

For the lower middle class, to say nothing of the genuinely poor, that's what HSAs will look like: periods of financial calm interrupted by medical catastrophe that rapidly transforms itself into crushing, long-term debt. Currently, more than half of bankruptcies are traceable to medical costs. Let's just say I wouldn't expect that number to go down under a system of HSAs. I do, however, expect the financial industry to post record profits. Silver linings and all that.